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Toe-brachial Pressure Index and Toe BP Predict Recurrent CV Events in T2DM

Major vascular disease is correlated with low TBI, not ABI…

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The detection of peripheral arterial disease is through the use of ankle-brachial pressure index (ABI) and toe-brachial pressure index (TBI). Myocardial infarction risk and cardiovascular death is said to be associated with low ABI, but few studies were performed to evaluate the correlation. Spanish researchers from the Hospital Universitario La Paz, Madrid, studied the correlation between ABI, TBI and toe BP and the risk of cardiovascular events.

Baseline parameters (men 74.1%, age 65.3 +/- 9.1 years, diabetes duration 13.4 +/- 9.2 years) were collected from 81 ACS patients. TBI and ABI were also measured using standard procedures. Data for eight patients were missing and three were excluded from the ABI analysis due to ABI ≥1.3. All major cardiovascular events (new episode of myocardial infarction, ischemic cerebrovascular disease, or peripheral arterial disease) were registered. Adjusted Cox proportional hazard regression models were used to evaluate recurrence for low ABI (<0.9), low TBI (<0.6), or low toe blood pressure (BP) (<50 mmHg).

During a follow up of 44.7 +/- 27.8 months, 27.1 % of subjects had at least one major cardiovascular (CV) events. Cox proportional hazards analysis (adjusted for sex, age, duration of diabetes, hypertension, dyslipidemia, smoking status, and mean A1C during follow-up) showed that low TBI and low toe pressure were predictors of CV events, but ABI was not.
Individuals with type 2 diabetes, low TBI and low toe BP with a history of CV events will develop a recurrence for future CV. Low ABI, however, will not be a factor for CV recurrence although it is a marker for arteriosclerosis.

With TBI unchanged, ABI’s ability to predict CV events is lowered in patients with diabetes and arteriosclerosis, calcification and stiffening of arteries. Major vascular disease is correlated with low TBI, an indicator of peripheral arterial disease, whereas ABI plays a minor role. Further studies are required to fully understand the role of TBI and toe BP as indicators for vascular test. Currently, CV recurrence in type 2 diabetes can be predicted with TBI and toe BP.

Practice Pearls:

  • Major vascular disease is correlated with low TBI, an indicator of peripheral arterial disease, whereas ABI plays a minor role.
  • CV recurrence in type 2 diabetes can be predicted with TBI and toe BP.
  • Low ABI, however, will not be a factor for CV recurrence although it is a marker for arteriosclerosis.

Martin-Fuentes et al. "Low Toe-Brachial Pressure Index Predicts Increased Risk of Recurrent Cardiovascular Disease in Type 2 Diabetes."Diabetes Care 2015;38:e53-e54.